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Methotrexate is an aminopterin derivative that acts via diverse and complex mechanisms to produce anti-proliferative, anti-inflammatory and immunosuppressive effects. As a folic acid antagonist, methotrexate inhibits purine and pyrimidine synthesis, resulting in antineoplastic activity at high dose levels. The anti-inflammatory activity of methotrexate, which is mediated by increased adenosine release, is considered to be most important for its clinical effect on psoriasis .In addition, the immune modulatory properties of methotrexate such as suppression of T-cell activation and altered expression of adhesion molecules are thought to be relevant.
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